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General NPI Number Information
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NPI Number | 1073059283
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Entity Type | Organization
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Legal Business Name | YANDRESCO QUINTANA DDS PC
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Dates
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Enumeration Date | 01/11/2017
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Last Update Date | 01/11/2017
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Provider Practice Location Address
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Address Line | 651 W 180TH ST SUITE 1
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City | NEW YORK
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State | NY
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Zip | 10033-4802
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Country | US
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Telephone | 212-927-0565
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Fax |
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Provider Business Mailing Address
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Address Line | 245 E 93RD ST APT 21A SUITE 1
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City | NEW YORK
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State | NY
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Zip | 10128-3960
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Country | US
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Telephone | 212-927-0565
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Fax |
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Authorized Official
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Title or Position | PRESSIDENT
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Name | YANDRESCO QUINTANA
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Credential | M.D. D.D.S.
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Telephone | 212-927-0565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 057383
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License Number State | NY
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